M&P
Which instructions should be given by the nurse to the patient in the second stage of labor to facilitate natural childbirth? A) Use a squatting position and use the squat bar for support B) Stay low on her back to ease the back pain C) Use the valsalva maneuver for effective pushing D) Ask for privacy and have just the partner present
Use a squatting position and use the squat bar for support
Pain is multi-factorial for women in labor. Which of the following is a psychosocial influence for a woman in labor? A) stretching of cervix C) pressure in the perineum B) decent of fetus into birth canal D) fear of pain during labor
fear of pain during labor
Jennifer has just received IV sedation. What must the nurse tell Jennifer to do? A) Ambulate only with assistance from the nurse or caregiver B) Ambulate within 15 minutes to prevent spinal headache C) Sit on the edge of the bed with her feet dangling before ambulating D) Remain in bed for at least 30 minutes
Ambulate only with assistance from the nurse or caregiver
Newer methods of pain control are under investigation, one under study is the use of intradermal water injection. Where is the water injected for pain control in a labor patient? A) Upper back B) Lower back C) Sacral area D) Illiac crest
Lower back
A woman in latent labor for the past 12 hours is requesting medication to help her rest. What medication should the provider prescribe? A) Secobarbital (Seconal) C) Fentanyl (Sublimaze) B) Meperidine (Demoral) D) Morphine
Secobarbital (Seconal)
What is the primary role of the nurse in pain management for a nurse working with labor patients? A) Provide any medication the patient request B) Dictate the pain management during labor for the best outcome C) Work with the labor patient to plan pain management options D) Monitor the patient for active labor and suggest she have an epidural to have increased satisfaction with her delivery experience
Work with the labor patient to plan pain management options
The nurse is assisting Monica through labor, monitoring her closely, now that she has received an epidural. The nurse would report which finding to the anesthesiologist? A) Dry, cracked lips C) Rapid progress of labor B) Urinary retention D) Inability to push
Inability to push
At which time during a woman's labor might the nurse assist with a pudendal block? A) Early stage labor C) Just before delivery B) Before dilation only D) Just after delivery
Just before delivery
Which type of pain is always associated with the first stage of labor? A) Stretching of the perineum C) Back ache B) Stretching of the cervix D) Pelvic bone pain
Stretching of the cervix
The laboring patient who is at 3cm dilation and 25 percent effaced is asking for analgesia. The nurse explains the analgesia is usually not administered prior to the establishment of the active phase. Identify the appropriate rationale for this practice. A) This would cause fetal depression in utero B) This may prolong labor and increase complications C) The effects would wear off before delivery D) This can lead to maternal hypertension
This may prolong labor and increase complications
Opiods are often used in labor for pharmacologic pain management. A patient in the transition phase of labor is requesting fentanyl (Sublimaze) for pain. How should the nurse respond to her request? A) "I will page the provider and ask for your pain medication." B) "You are so close to delivery, don't you want to have natural child birth?" C) "Pain medication given now might cause the baby to have slow respirations and is not recommended, lets try to focus and breathe." D) "Rather than use fentanyl, we can ask the provider to order another analgesic at this point."
"Pain medication given now might cause the baby to have slow respirations and is not recommended, lets try to focus and breathe."
What should the nurse's best response be to help the patient remain calm and cooperative during delivery? A) "The baby is coming. Relax and everything will turn out fine." B) "Do you want me to call in your family? C) "Even though the baby is coming, the doctor will be here soon." D) "The baby is coming. I'll explain what's happening and guide you."
"The baby is coming. I'll explain what's happening and guide you."
After administration of epidural anesthesia during labor, the patient develops a temperature of 100.1F. The patient's husband is asking if she is "getting sick". How should the nurse respond to the patient and her husband? A) "We will have to take her temperature every 30 minutes and might start antibiotics." B) "This elevation in temperature is a possible side effect of the anesthesia. We will notify the provider and assess temperature again in an hour." C) "Can you tell me if you have been exposed to any illnesses you might be developing?" D) "Due to the length of your labor, you might be dehydrated and that may cause your temperature to rise, let's get you something to drink."
"This elevation in temperature is a possible side effect of the anesthesia. We will notify the provider and assess temperature again in an hour."
The nurse instructs the client about skin massage and the gate control theory of pain. Which of the following statements would be appropriate for the nurse to include for patient understanding of the nonpharmacological pain relief methods? A) The gating mechanism is located at the pain site B) Pain perception is decreased if anxiety is present C) The gating mechanism opens so all the stimuli pass through to the brain D) A technique to prevent the painful stimuli from entering the brain
A technique to prevent the painful stimuli from entering the brain
Susan is in labor with her second child. She knows that she will want epidural anesthesia and she has already signed her consent form. What must the nurse do before Susan receives the epidural? A) Review Susan's medical history and laboratory results, and interview Susan to confirm all information is accurate and up to date B) Place Susan in the fetal position on the table and keep her steady so that she won't move during the procedure C) Administer a fluid bolus through the IV line to reduce the risk of hypotension D) Prepare a sterile field with the supplies and medications that will be needed
Administer a fluid bolus through the IV line to reduce the risk of hypotension
A patient of 41 weeks gestation has been in labor for 18 hours and the fetus is now showing signs of distress. The anesthesiologist has recommended a general anesthetic, the patient cannot have an epidural due to prior back surgery. The nurse should plan to administer which medication prior to taking the patient to the operating room? A) Pain medication C) Antacid B) Non-steroidal anti-inflammatory D) Sedative
Antacid
Marie, a 21-year-old first-time mother in the second stage of labor, has been moaning and screaming and generally vocal throughout her labor. Her husband is distraught seeing his wife this way and comes to the nurse asking that his wife receive more pain medication. How should the nurse respond? A) Assist Marie with breathing and imagery techniques in an attempt to calm her down B) Reassure the first-time father that Marie will be fine and offer to stay with her while he takes a walk C) Page the obstetrician to evaluate Marie's pain and administer an appropriate increase in her pain medication D) Ask Marie to describe the intensity of her pain on a scale of 0 to 10
Ask Marie to describe the intensity of her pain on a scale of 0 to 10
Betsy is recovering from a standard delivery. The nurse has just removed Betsy's epidural catheter and applied a sterile pressure dressing. What is it important for the nurse to do now? A) Assess return of sensory and motor functions to the lower extremities B) Help Betsy to get up and walk around immediately C) Let Betsy rest and recover while keeping her legs slightly elevated D) Make sure that Betsy receives plenty of fluids
Assess return of sensory and motor functions to the lower extremities
The labor patient is prepared for natural childbirth and has brought with her a picture to use as her object for imagery during labor. What type of nonpharmacological pain management is this considered? A) Relaxation technique C) Attention focusing B) Continuous labor support D) Hypnosis
Attention focusing
Erin, a 19-year-old first-time mother in the second stage of labor who has been given an epidural, reports severe, unrelenting abdominal pain and rates it as 10 on a scale of 0 to 10. As the nurse, what should you do? A) Proceed with standard care; the nurse knows that this is typical in the second stage of labor and that younger women and those who are first-time mothers are more likely to report severe pain. B) Call the obstetrician; severe unrelenting abdominal pain could indicate placental abruption, uterine rupture, or other undiagnosed complication. C) Call the anesthetist, who is responsible for managing the epidural and should be monitoring Erin's pain. D) Discuss with Erin the additional pain medication options available to her at this stage in her labor so that she can choose which option she prefers.
Call the obstetrician; severe unrelenting abdominal pain could indicate placental abruption, uterine rupture, or other undiagnosed complication.
Which of the following would be the best way the nurse can facilitate an effective birth plan for the patient to achieve adequate pain relief? A) The client has the baby without any analgesic or anesthetic B) The health care provider decides the best pain relief for the mother and family C) Client priorities and preferences are incorporated into the plan D) The nurse prescribes alternative methods of pain relief
Client priorities and preferences are incorporated into the plan
A woman is experiencing back labor and complains of intense pain in the lower back. Which is the most effective nursing intervention to relieve this type of pain? A) Effleurage of the abdomen during the contraction B) Conscious relaxation/guided imagery in low fowlers C) Counter pressure against the sacrum D) Pant-blow (breaths and puffs breathing techniques)
Counter pressure against the sacrum
The patient is G1 P0, in the second stage of labor and is at 2+ station and in anticipation of delivery within the hour. Her epidural did not work and she is begging for Demerol. Which is the most appropriate action by the nurse? A) At the nurses' station call the anesthetist to retry the epidural B) Call the doctor and obtain a reduced dose of Demerol C) Give the Demerol because she needs pain relief now D) Encourage her through the contractions and explain not giving the Demerol
Encourage her through the contractions and explain not giving the Demerol
The following are nursing measures commonly offered to women in labor. Which nursing intervention would probably be most effective in applying the gate control theory for relief of labor pain? A) Encourage the woman to rest between contractions B) Change the woman's position C) Give the prescribed medication D) Massage for the woman's back
Massage for the woman's back
The patient is 5 cm dilated, 80 percent effaced, and 0 station. Her contractions are increasing to every 2-3 minutes, lasting 50 seconds. The client is increasingly uncomfortable. She is apprehensive but appropriate and focused on her breathing and relaxation. Select the most appropriate nursing diagnosis for the client. A) Risk for altered tissue perfusion related to breathing techniques B) Impaired gas exchange related to prolonged contractions C) Pain related to increasing frequency and intensity of contractions D) Ineffective individual coping related to fear and anxiety
Pain related to increasing frequency and intensity of contractions
Nancy has presented in the early phase of labor. She's experiencing abdominal pain and shows signs of growing anxiety about the pain. What is the best pain management technique the nurse can suggest at this stage? A) Immersing Nancy in warm water in a pool or hot tub B) Practicing effleurage on the abdomen C) Administering a sedative such as secobarbital (Seconal) or pentobarbital (Nembutal) D) Administering an opioid such as meperidine (Demerol) or fentanyl (Sublimaze)
Practicing effleurage on the abdomen
A woman in labor at the hospital has just received an epidural block. Which intervention is priority before and during epidural placement? A) Increase oral fluids every hour to prevent dehydration B) Provide adequate IV fluids to maintain her blood pressure C) Monitor temperature every four hours and give Tylenol if 100.4 D) Monitor the maternal apical pulse for Bradycardia
Provide adequate IV fluids to maintain her blood pressure
A woman dilated to 10 centimeters and feeling the urge to "have a bowel movement" is refusing to push, she is screaming "it hurts down there too much to push." What is the option the nurse should suggest at this point for pain management to facilitate pushing? A) Epidural anesthesia C) Paracervial block B) Pudendal block D) Parenteral medication
Pudendal block
Sarah has just arrived at the hospital, in early labor, showing signs of extreme anxiety over the birth to come. Why is it so important that the nurse help Sarah relax? A) Sarah's anxiety will increase her blood pressure, increasing her risk with an epidural B) This is the time at which the nurse must establish that she is in control; she will be taking care of Sarah and Sarah needs to trust the nurse C) Sarah's anxiety can actually slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus D) Sarah needs to sleep now so that she can save her energy for the later stages of labor
Sarah's anxiety can actually slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus
Jane and her husband have attended childbirth preparation classes and they feel very hopeful and optimistic about having a natural childbirth. As Jane progresses to 8cm dilation, she can no longer endure the pain at the peak of each contraction and she begs the nurse for an epidural. How can the nurse best help Jane? A) Suggest a less extreme alternative such as a sedative B) Support Jane's decision and call the obstetrician to discuss the epidural with Jane C) Gently remind Jane of her goal of natural childbirth, encouraging her and helping her to focus her breathing D) Ask Jane's husband to gently remind her of their goal of natural childbirth and to encourage her to focus on using the breathing and imagery techniques they learned in childbirth class together
Support Jane's decision and call the obstetrician to discuss the epidural with Jane
